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Prescription Drug Benefits

Is your prescription covered under your plan? The Formulary Search tool can give you the answer.

Most Martin's Point Generations Advantage plans include comprehensive Part D Prescription Drug coverage and offer a national pharmacy network and vaccine coverage, low copays, competitive premiums, a national pharmacy network—all included in your monthly plan premium.

All Part D coverage is based on a prescription drug formulary—a list of covered drugs that have been selected in consultation with a team of health care providers. Formularies can vary by plan.


Things you might want to consider when reviewing Part D Prescription Drug coverage:

  • Is your preferred pharmacy in the plan network?
  • Are your medications covered under the plan formulary (list of covered drugs)?
  • Does the plan offer generic options for cost savings?
  • Can you save on mail-order medications with 30-day or 90-day supplies?


2024 Drug Formularies & Network Pharmacies

Martin’s Point Generations Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at one of our network pharmacies, and other related plan rules are followed. Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available. 

Our Prime, Select, Value Plus, and Access, feature comprehensive Part D Prescription Drug coverage. Search the online formulary or download a PDF document of your plan's formulary to find specific information about drug costs, copays, and drug tiers for your plan.

Before you enroll, use our Formulary Search tool to look up your prescriptions and their costs. You can customize your search selections to fit your specific needs and find out which in-network pharmacies are nearby using our Pharmacy Search tool.


Explore our Drug Formulary & Pharmacy Network:
PLAN NAME ONLINE FORMULARY SEARCH PRINTED FORMULARY LIST
Prime, Select, Access Search Formulary Prime, Select, Access 2024 Plan Formulary (PDF)
Value Plus Search Formulary Value Plus 2024 Plan Formulary (PDF)
PHARMACY NETWORK ONLINE PHARMACY SEARCH
All Plans Search Pharmacy Network
Next steps:
How Martin's Point can help

We have local benefit specialists available to help you with your questions or give you personalized assistance.

1-888-412-0780 (TTY: 711)

Which Plan Is Right For You?

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Compare Part D Prescription Drug coverage for Prime, Select, Value Plus, and Access plans to find the right fit for your needs:

Your drug costs depend on what tier your drug is in, what "coverage phase" you are in, when you get the drug, and which pharmacy you use. For more information, see the "Drug Coverage Phases" accordion located below.


PRESCRIPTION DEDUCTIBLE: $0 
MEMBER COSTS IN INITIAL COVERAGE PHASE

 

TIER 1: Preferred Generic

TIER 2: Generic

TIER 3: Preferred Brand

TIER 4: Non-Preferred

TIER 5: Specialty

 TIER 6:
Select Care Drug
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 30-day supply* $0 $10 $40 $95 33% of cost  $0 
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 90-day supply* $0 $30 $120 $285 Not Covered $0
Pharmacies with standard cost sharing, 30-day supply*  $4 $18 $47 $100 33% of cost $4
Pharmacies with standard cost sharing, 90-day supply* $12 $54 $141 $300 Not Covered $12
Mail order, 90-day supply*  $10 $45 $117.50 $250 Not Covered  $0 

IMPORTANT NOTE ABOUT PRESCRIPTION PRICING: In some cases, the cost of a drug is lower than the copay amount of its Tier. In that situation, the plan would only charge the member the amount of the medication, not the full copay amount.

Your drug costs depend on what tier your drug is in, what "coverage phase" you are in, when you get the drug, and which pharmacy you use. For more information, see the "Drug Coverage Phases" accordion located below.


PRESCRIPTION DEDUCTIBLE: $275

The deductible applies to covered drugs in Tiers 3, 4, and 5. You will pay the full cost for drugs in these tiers until the $275 deductible is met. Then you will enter the Initial Coverage Phase for drugs in these tiers. For drugs in Tiers 1, 2, and 6, you start immediately in the Initial Coverage Phase.

MEMBER COSTS IN INITIAL COVERAGE PHASE

 

TIER 1: Preferred Generic

TIER 2: Generic

TIER 3: Preferred Brand

TIER 4: Non-Preferred

TIER 5: Specialty

 TIER 6:
Select Care Drug
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 30-day supply* $0 $10 $40 $95 29% of cost  $0 
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 90-day supply* $0 $30 $120 $285 Not Covered $0
Pharmacies with standard cost sharing, 30-day supply*  $4 $18 $47 $100 29% of cost $4
Pharmacies with standard cost sharing, 90-day supply* $12 $54 $141 $300 Not Covered $12
Mail order, 90-day supply*  $10 $45 $117.50 $250 Not Covered  $0 

IMPORTANT NOTE ABOUT PRESCRIPTION PRICING: In some cases, the cost of a drug is lower than the copay amount of its Tier. In that situation, the plan would only charge the member the amount of the medication, not the full copay amount.

Your drug costs depend on what tier your drug is in, what "coverage phase" you are in, when you get the drug, and which pharmacy you use. For more information, see the "Drug Coverage Phases" accordion located below.


PRESCRIPTION DEDUCTIBLE: $275

The deductible applies to covered drugs in Tiers 3, 4, and 5. You will pay the full cost for drugs in these tiers until the $275 deductible is met. Then you will enter the Initial Coverage Phase for drugs in these tiers. For drugs in Tiers 1, 2, and 6, you start immediately in the Initial Coverage Phase.

MEMBER COSTS IN INITIAL COVERAGE PHASE

 

TIER 1: Preferred Generic

TIER 2: Generic

TIER 3: Preferred Brand

TIER 4: Non-Preferred

TIER 5: Specialty

 TIER 6:
Select Care Drug
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 30-day supply* $0 $10 $40 $95 29% of cost  $0 
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 90-day supply* $0 $30 $120 $285 Not Covered $0
Pharmacies with standard cost sharing, 30-day supply*  $4 $18 $47 $100 29% of cost $4
Pharmacies with standard cost sharing, 90-day supply* $12 $54 $141 $300 Not Covered $12
Mail order, 90-day supply*  $10 $45 $117.50 $250 Not Covered  $0 

IMPORTANT NOTE ABOUT PRESCRIPTION PRICING: In some cases, the cost of a drug is lower than the copay amount of its Tier. In that situation, the plan would only charge the member the amount of the medication, not the full copay amount.

Your drug costs depend on what tier your drug is in, what "coverage phase" you are in, when you get the drug, and which pharmacy you use. For more information, see the "Drug Coverage Phases" accordion located below.


PRESCRIPTION DEDUCTIBLE: $300

The deductible applies to covered drugs in Tiers 3, 4, and 5. You will pay the full cost for drugs in these tiers until the $300 deductible is met. Then you will enter the Initial Coverage Phase for drugs in these tiers. For drugs in Tiers 1 and 2, you start immediately in the Initial Coverage Phase. The Value Plus plan does not include coverage for Tier 6 drugs.

MEMBER COSTS IN INITIAL COVERAGE PHASE

 

TIER 1: Preferred Generic

TIER 2: Generic

TIER 3: Preferred Brand

TIER 4: Non-Preferred

TIER 5: Specialty

 TIER 6:
Select Care Drug
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 30-day supply* $0 $10 $40 $95 28% of cost  Not Covered
Pharmacies with preferred cost sharing (including Hannaford pharmacies), 90-day supply* $0 $30 $120 $285 Not Covered Not Covered
Pharmacies with standard cost sharing, 30-day supply*  $4 $18 $47 $100 28% of cost Not Covered
Pharmacies with standard cost sharing, 90-day supply* $12 $54 $141 $300 Not Covered Not Covered
Mail order, 90-day supply*  $10 $45 $117.50 $250 Not Covered Not Covered

IMPORTANT NOTE ABOUT PRESCRIPTION PRICING: In some cases, the cost of a drug is lower than the copay amount of its Tier. In that situation, the plan would only charge the member the amount of the medication, not the full copay amount.

Our Generations Advantage Select, Value Plus, and Access plans have a deductible for certain drug tiers that must be met before entering the Initial Coverage Phase. 
number one icon DEDUCTIBLE PHASE

FOR PLANS WITH A DEDUCTIBLE: The deductible applies to covered drugs in Tiers 3, 4, and 5. You will pay the full cost for drugs in these tiers until the plan's deductible is met. Then you will enter the Initial Coverage Phase for drugs in these tiers.

For drugs in Tiers 1, 2, and 6, you start immediately in the Initial Coverage Phase.
number one iconINITIAL COVERAGE PHASE*
You begin this phase when you fill your first prescription of the year and pay set copays or cost shares (noted under your plan below) for covered drugs until the total yearly drug costs (what you pay PLUS what the plan pays) reach $5,030. 
number one iconCOVERAGE GAP PHASE*

After the total yearly drug costs (what you pay PLUS what the plan pays) reach $5,030, you will enter the Coverage Gap phase. In this phase, you pay 25% of the cost for generic drugs. For brand-name drugs, you receive a manufacturer’s discount, and you will pay 25% of the discounted cost plus a portion of the dispensing fee (NOTE: Tier 6 copays in this phase are $0 for 30- and 90-day supplies at preferred retail and mail-order pharmacies, and 15% coinsurance at standard retail pharmacies).

  1. The total out-of-pocket drug costs YOU paid in the Deductible phase (if your plan has a Part D deductible) PLUS
  2. The total out-of-pocket drug costs YOU paid in the Initial Coverage phase PLUS
  3. The total out-of-pocket drug costs and dispensing fees YOU paid in the Coverage Gap phase PLUS
  4. The total amount of the manufacturer’s discount you received in the Coverage Gap phase.

(PLAN costs from all phases ARE NOT COUNTED in the Coverage Gap phase)

Once the total reaches $8,000, you move into the Catastrophic Coverage phase.
number one iconCATASTROPHIC COVERAGE PHASE*
Once you have moved into the Catastrophic Coverage phase, you pay $0 for covered drugs for the remainder of the year.
Have questions? Explore Generations Advantage plans with Part D prescription drug coverage in detail:

PRIME (HMO-POS) | SELECT (LPPO) | ACCESS (LPPO) | VALUE PLUS (HMO-POS)

 

Common Questions

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Martin's Point Generations Advantage is happy to offer a network of pharmacies with preferred cost sharing—including Hannaford Pharmacies, CVS Pharmacies, and Martin's Point Health Care Center Pharmacies in Portland, ME and Portsmouth, NH.

In the network of pharmacies with preferred cost sharing, Generations Advantage members receive medications in all tiers of the Generations Advantage formulary (covered drug list) at lower copays than at pharmacies with standard cost sharing.

The Centers for Medicare and Medicaid Services (CMS) can change the list of covered prescription drugs at any time. All changes are subject to their issued policy and can only occur when specific guidelines are met.

Please note that there may be times when certain drugs will not be displayed within the online search results. To view a document containing the complete list of covered drugs within the search results or after you have selected your plan, click “View List of Covered Drugs."